Group Quarters

THIS LISTING CONTAINS CONFIDENTIAL INFORMATION, THE RELEASE OF WHICH IS PROHIBITED BY TITLE 13, U.S.C., OMB NO. XXXX-XXXX-DR APPROVAL
EXPIRES MM/DD/YYYY
Form DH-941(GQE)
US Department of Commerce GQ Name:
(5-11-2017)
Economics and Statistics Administration
U.S. Census Bureau GQ ID:
Control Number:
GQ Contact Name:

Group Quarters Enumeration
Reinterview Form
2018 Census Test

Enumerator Name (Lead):
Enumerator ID:
ACO:

Complete :

GQ Contact Telephone Number:

Reinterview Date (Month/Day/Year):

____________________________

RI Clerk Name:

If telephone number is different, record here:

Clerk ID:

____________________________

Reinterview Introduction:
Read verbatim below.
"Hello, my name is (your name) from the U.S. Census Bureau. I'm calling to check on the quality of our census interviews.
My records indicate this facility was recently enumerated. May I please speak with _________________________________?"
If original respondent is unavailable, ask , "May I speak with someone else who can answer my questions?"
Enter respondent's name: _______________________________.
If not, ask when either individual would be available for a call back. Write call back time & date in the notes space below.
Update the GQ Contact Telephone Number box, if needed.

T

Section A GQE — FACILITY VERIFICATION
1. Our records show our Census enumerator visited your facility on or about ____________ (transcribe date from
DH-352.1, item 30) to count your clients. Is that correct?

AF

(Check respondent's answer)
☐ Yes
☐ No - Thank respondent and end interview. Record response below .
__________________________________________________________________________________________
☐ I don't know.
2. What is the approximate number of clients you think were counted at your facility at that time? This number might be different
than the maximum number of clients you could service at your facility.

R

______________ Number of clients

☐ I don't know - Enter any explanation in notes section.

Tolerance
Calculation

D

This ends our interview. Thank you very much for your time in answering these questions.
Section B — REINTERVIEW RESULTS — ADMINISTRATIVELY RESTRICTED — SUPERVISORY USE ONLY
If there is a "Number of clients" entry in question 2, calculate tolerance:
_____________________

/

______________________ = ____________________________

Count entry from Q2 divided by # of ICQs from DH-352.1, item 31 = Result
Determining Final Outcome:
• If Question 1 is "Yes" or "I don't know," and tolerance is more than or equal to .8 and less than or equal to 1.2 - Mark "Pass."
Otherwise, conduct an investigation.
• If Question 1 is "No," or Questions 1 and 2 are "I don't know" - Conduct an investigation.
If investigation results indicate respondent error or honest enumerator error - Mark "Soft Fail."
If investigation results indicate enumerator falsification - Check "Hard Fail Recommendation."
☐ Hard Fail Recommendation (Discuss situation with ACOM.)
Final Outcome (Mark only one box and key into OCS. )
☐ Pass
☐ Soft Fail
☐ Hard Fail (Mark only if directed by ACOM.)
☐ Unable to Contact
NOTES (Please use this section to provide any additional information.)